The information in this video is new.
Not all health-care providers know about it.
So feel free to share this video with your baby's health-care provider.
We probably give 18 to 20 needles, sometimes
more, in the first 18 months of life.
Vaccinations are a routine part of a baby's medical care
and keep babies healthy.
But the pain of vaccinations can be distressing for babies and parents.
And these negative experiences lead parents to delay or not vaccinate children.
"I think she remembers last time she was here."
"Is that possible?"
The statistics would suggest that about 10% of people
avoid immunizations because of fear of needles.
Many parents do not speak up about their baby's pain because
they don't know what they can do about it.
"She was already worked up before it even started,
because she remembered."
In this video, we'll show you ways to reduce pain
during your baby's vaccinations.
They fit into 3 groups:
What you can give:
topical anesthetics and sugar water.
What you can do:
child-positioning and breastfeeding.
And how you can act:
your state of mind and distracting your baby.
Combining the different methods together will lead to better results.
Look at this baby's response to the needle.
You'll notice there are minimal signs of pain.
Observe the baby's body movements, facial actions and sounds.
So, let's get started showing you how to use these methods so
you can reduce pain in your baby during the next vaccination.
Hospitals all over the world use topical anaesthetics to reduce pain in babies.
They dull the pain where the needle enters the baby's skin.
In Canada, you can buy topical anesthetics at the drug store without a prescription.
They're safe to use in all ages, including newborns.
They're available as a cream, gel or patch.
Most people have experience with them at the dentist's office.
"Here we go!"
"It's where the needles are going to go..."
For babies under 12 months of age, the anaesthetic is usually
applied to the upper leg, and for children aged a year or older, to their upper arm.
You need to wait for topical anaesthetics to take effect.
Maxilene takes 30 minutes to work,
Ametop takes 45 minutes,
and EMLA takes 60 minutes.
If you expect to wait at the clinic, then you might want to apply
them there, instead of at home.
Just peel off the backing and stick the patch on the skin.
If you are using the cream or gel, squeeze it out of the tube
in a circular pattern on the dressing that's provided
until it's about the size of a nickel.
This is 1 gram of the anaesthetic, equivalent to one dose.
And then put the dressing on your baby's skin.
Make sure the edges are sealed so the anaesthetic doesn't leak out.
Fold over one corner of the dressing onto itself so you have an edge to grab
onto later to make it easier to take it off.
If the dressing is not available, you can use plastic wrap.
Just wrap it around the baby's leg or arm.
Ask your doctor whether your baby is scheduled for one or
more vaccinations so you know whether to apply the anaesthetic
to one or both legs or arms.
"Now, I'm going to put the time on there..."
Make a note of the time you applied them, or write it directly
on the dressing or patch with a pen so that you can make sure
you remember to take them off at the appropriate time.
Remove the dressing carefully, as it can get very sticky.
If you pull it off too quickly, it may cause your baby
discomfort, like when you pull off a bandage.
Instead, pull the dressing out and away from the skin, slowly,
while securing the opposite corner.
The dressing stretches, and it will lift off the skin without causing discomfort.
Then just wipe the skin with a tissue.
You can use a washable marker to show where the anaesthetic was
because sometimes you can't tell after you take it off.
You might notice some changes to the colour of your baby's skin—
either reddening or whitening.
This is temporary and goes away after a few hours.
Rarely, there can be a skin rash, which can be a sign of
an allergic skin reaction.
If that happens, ask your baby's health-care provider about using
a different topical anaesthetic product the next time.
You can control your baby's physical pain
during vaccinations with sugar water.
There are many randomized control trials that have shown
that sugar water seems to be an effective way of reducing pain.
"What do you think?"
Probably by a number of mechanisms.
Whether it's just the taste that these little infants have in their
mouth, which is distracting them, or whether there's some interference
in the neurological pathways, it really seems to be effective.
You can make your own sugar water.
Just mix a packet of white sugar, which is about one teaspoon or 5 mLs,
in two teaspoons, or 10 mLs, of water.
You can use distilled water or boiled water.
You can use tap water in older infants if you know
that the water in your area is safe for drinking.
Put a drop at a time in your baby's mouth, about a minute or two before
the needle, using a dropper, syringe or medicine cup.
You can also dip a soother in sugar water and give your baby the soother
to suck on during the needle.
"Oh, good boy!"
Be careful not to squirt the sugar water directly in the middle of your baby's mouth.
This can cause your baby to gag or spit up.
Instead, put it on the side of the baby's mouth, inside the cheek.
Hospitals use sugar water to reduce pain in babies, even newborn babies.
It is safe and effective, but only use this as a pain medicine,
not as a general comfort or as a food.
Controlling your baby's physical pain with breastfeeding.
You can breastfeed your baby during vaccinations instead of giving sugar water.
Breastfeeding is one of the best ways to reduce pain in babies.
Babies benefit from being comfortable in their mother's
arms the sweet taste of milk, and sucking.
It is a very effective physical comfort for babies during painful procedures.
Start breastfeeding your baby about a minute or two before the needle.
And make sure there's a good latch.
Then, continue to breastfeed your baby during and after the needle.
Your baby's legs or arms can be exposed so that
the needle can be given easily.
Breastfeeding during vaccinations is safe.
There is no evidence at all that babies will gag or learn
to associate their mothers with pain.
If you cannot breastfeed, hold your baby and give
sugar water with or without a soother.
Your baby's body position during vaccination can affect
how much pain your baby feels.
Holding your baby upright can reduce your baby's pain during vaccinations.
You can hold your baby in different ways:
Facing you, chest to chest.
Or hold your baby facing sideways.
You can stand or sit or lean against the examination table.
In all cases, providing a hugging hold and exposing your baby's limbs for the needle.
If the needle is going into your baby's arm, make sure the arm is exposed,
holding it firmly but gently so that your baby won't move it.
If the needle is going into your baby's thigh, make sure the thigh
is exposed, bracing it gently but firmly for the needle.
Babies should always be held during injections.
"I'm right here."
Before, during, and after the needle.
Try to avoid leaving babies on their back, held down,
or without parents, as this can make them afraid,
which can increase their distress during vaccinations.
And we've shown in studies that infants who are held by
the mother—that there's significantly less pain.
So it makes sense that you should be holding, the mother
should be holding, the caregiver should be holding, their infant
at the time the vaccine is given.
"Hold their hand."
Discuss different positioning options with your baby's
health-care provider and practise ahead of time.
Try not to use too much force when holding your baby,
as this can increase your baby's distress.
Controlling pain during vaccination with your state of mind.
Be there for your baby.
Having a parent there makes a baby feel more secure.
During vaccinations, be calm, use your normal voice, and be positive.
This will make it better for your baby.
Your baby looks to you for how to act and feel,
so you can make it better or worse.
If you are stressed, your baby will pick up on that, and that
will make your baby more stressed too.
One of the best ways to quickly become less stressed is to
take a few deep belly breaths while holding your infant.
Your baby will feel your rhythmic breathing,
and this alone is very calming.
Simply take a slow, deep breath through your nose, for 3 seconds,
counting to yourself: "1... 2... 3..."
And breathing so that it's your belly and not your chest that expands.
And then exhale through your mouth for 3 seconds,
counting: "1... 2... 3..."
Take 3 breaths like this while cuddling your baby.
The way the mother smiles, the way the mother holds the baby,
the way the mother talks— what's the tone of the voice?
Sometimes it's a language they use.
"Not yet, not yet."
During distressing times like immunizations,
the best thing to do, after you let them know that you are there
for them by bringing them close, is to talk about anything
but the needle, or the pain, and with a normal tone of voice.
Even if your baby doesn't understand your words, they understand your tone.
"Oh my. I know. That was kind of annoying, wasn't it?"
"Now you want to get down and play."
"You want to play with your brother and do bubbles."
Distract your baby.
Controlling your baby's pain during vaccination with distraction.
Your baby's activity during vaccination can affect how
much pain your baby feels.
Distract your baby with singing,
You can distract an older baby with toys too, such as:
bubbles, pop-up books, rattles or smartphones.
Distracting your baby can only happen when they are ready to be distracted.
Trying to distract when your child is not ready will cause
them to become even more distressed.
If your infant isn't ready, just return to cuddling for a little longer.
You can try distracting your baby with toys again sometime
between 20 seconds and 1 minute after the needle.
The way you distract your baby once may not work the next time.
Be prepared to change what you are doing.
Children have a right to the most comfortable experience possible.
Controlling your baby's pain during vaccinations is important.
Not all babies experience vaccinations the same way,
but these methods can help all children to have less pain.
Make a goal for your baby's next vaccination
so you can plan to take any supplies you need,
like topical anaesthetics or sugar water, and practise ahead of time.
Talk to your baby's health-care provider about what you want to do.
And remember—combine the different methods for the best results.
"You're in no pain, no pain. Yaaay!"